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WP: Abstinence-only programs might work, study says


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Abstinence-only programs might work, study says

Sex education classes that focus on encouraging children to remain abstinent can persuade a significant proportion to delay sexual activity, researchers reported Monday in a landmark study that could have major implications for U.S. efforts to protect young people against unwanted pregnancies and sexually transmitted diseases.

Only about a third of sixth- and seventh-graders who completed an abstinence-focused program started having sex within the next two years, researchers found. Nearly half of the students who attended other classes, including ones that combined information about abstinence and contraception, became sexually active.

The findings are the first clear evidence that an abstinence program could work.

"I think we've written off abstinence-only education without looking closely at the nature of the evidence," said John B. Jemmott III, a professor at the University of Pennsylvania who led the federally funded study. "Our study shows this could be one approach that could be used."

The research, published in the Archives of Pediatric & Adolescent Medicine, comes amid intense debate over how to reduce sexual activity, pregnancies, births and sexually transmitted diseases among children and teenagers. After falling for more than a decade, the numbers of births, pregnancies and STDs among U.S. teens have begun increasing.

There's more at the link, and I think this probably merits its own thread, not one dug up from months ago, which began with a shaky premise, and which requires people to read 9 pages to see that there's something new.

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Here's the key part to this story:

Several critics of an abstinence-only approach said that the curriculum tested did not represent most abstinence programs. It did not take a moralistic tone, as many abstinence programs do. Most notably, the sessions encouraged children to delay sex until they are ready, not necessarily until married; did not portray sex outside marriage as never appropriate; and did not disparage condoms.

"There is no data in this study to support the 'abstain until marriage' programs, which research proved ineffective during the Bush administration," said James Wagoner, president of Advocates for Youth.

So any attempt to extrapolate this study into a simplistic conclusion that "Abstinence-only works" would be wrong.

This particular version of abstinence education seems to work, at least for this group of students (the study was done on 622 african american children in one northeastern city -- whether this can be extrapolated to all other demographics is the subject of another study). Most abstinence-only programs do not operate like the one involved in this study.

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Here's the key part to this story:

I would classify it more as a key, rather than the key, but I suppose it depends on one's point of view.

Personally, I thought it was interesting that the study was done over 5 years ago, and they're only publishing now. Solid scholarship takes a long time.

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first this:

Several critics of an abstinence-only approach said that the curriculum tested did not represent most abstinence programs. It did not take a moralistic tone, as many abstinence programs do. Most notably, the sessions encouraged children to delay sex until they are ready, not necessarily until married; did not portray sex outside marriage as never appropriate; and did not disparage condoms.

then this:

The abstinence program had no negative effects on condom use, which has been a major criticism of the abstinence approach.

This particular abstinence only program seems decidedly different than the usual stuff. It's basically pleading with kids to wait a few more years without the usual scare tactics.

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I recently heard something about a group of over 10,000 students that made a pledge to absinence. 88% of them admittedly broke the pledge. IMO, the number might even be greater, if not for students trying to maintain their wholesome image.

I remember that as well. It all depends on how long of a horizon you look at.

This particular study looked two years down the road. So the most that can be said about this study is that abstinence-only education for 6th and 7th graders was most effective at delaying sex, as long as that form of abstinence-only education did not preach negatively about sex, did not disparage condoms or birth control, and did not insist on abstinence until marriage.

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My issue is that they waited longer to have sex, but did they now how to have safe sex once they did it?

The study states that this particular abstinence-only class did not have any impact on condom use. Which means that there was no difference in unprotected vs. protected sex among the participants, regardless of which course they took.

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So the most that can be said about this study is that abstinence-only education for 6th and 7th graders was most effective at delaying sex, as long as that form of abstinence-only education did not preach negatively about sex, did not disparage condoms or birth control, and did not insist on abstinence until marriage.

I'm not sure the "as long as" is totally justified, but this seems about right.

I think most people would value teenagers delaying sex, regardless of the time period. I know I would. I've seen too many 15 year old mothers.

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The study states that this particular abstinence-only class did not have any impact on condom use. Which means that there was no difference in unprotected vs. protected sex among the participants, regardless of which course they took.

Maybe I read that differently then. I took it as they don't discourage condoms but weren't teaching how to use them and the value of using them. no?

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I'm not sure the "as long as" is totally justified, but this seems about right.

I think most people would value teenagers delaying sex, regardless of the time period. I know I would. I've seen too many 15 year old mothers.

Well, I included "as long as" because the results of this study cannot be divorced from the specific type of abstinence-only course that was given. This is so because there are plenty of other studies showing that the typical variety of abstinence-only courses are not as effective in reducing teenage, and in fact tend to be harmful in other ways (i.e., disparaging birth control and condoms leading to more unprotected sex down the line).

And I think everyone agrees that teenage sex should be minimized if possible, as long as information about birth control is also available if requested. This particular course in the study seems to be one that should be attempted elsewhere.

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There's a difference between abstinence only and abstinence focused.

That's true, but this was apparently abstinence only, unless you think the lead researcher was confused about the meaning of the term:

I think we've written off abstinence-only education without looking closely at the nature of the evidence," said John B. Jemmott III, a professor at the University of Pennsylvania who led the federally funded study. "Our study shows this could be one approach that could be used."
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Maybe I read that differently then. I took it as they don't discourage condoms but weren't teaching how to use them and the value of using them. no?

No, you're right. They didn't "disparage" condoms or birth control, but the abstinence-only course also didn't discuss it at all either.

The authors of the study say that there were no differences among the groups in unprotected vs. protected sex, once those who had sex went ahead with it. That means that this particular abstinence-only course did not lead to any increase in unsafe sex over those who took other kinds of courses.

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For those who have professional access (or 15 dollars), here's the actual study. This is the abstract information:

Objective To evaluate the efficacy of an abstinence-only intervention in preventing sexual involvement in young adolescents.

Design Randomized controlled trial.

Setting Urban public schools.

Participants A total of 662 African American students in grades 6 and 7.

Interventions An 8-hour abstinence-only intervention targeted reduced sexual intercourse; an 8-hour safer sex–only intervention targeted increased condom use; 8-hour and 12-hour comprehensive interventions targeted sexual intercourse and condom use; and an 8-hour health-promotion control intervention targeted health issues unrelated to sexual behavior. Participants also were randomized to receive or not receive an intervention maintenance program to extend intervention efficacy.

Outcome Measures The primary outcome was self-report of ever having sexual intercourse by the 24-month follow-up. Secondary outcomes were other sexual behaviors.

Results The participants' mean age was 12.2 years; 53.5% were girls; and 84.4% were still enrolled at 24 months. Abstinence-only intervention reduced sexual initiation (risk ratio [RR], 0.67; 95% confidence interval [CI], 0.48-0.96). The model-estimated probability of ever having sexual intercourse by the 24-month follow-up was 33.5% in the abstinence-only intervention and 48.5% in the control group. Fewer abstinence-only intervention participants (20.6%) than control participants (29.0%) reported having coitus in the previous 3 months during the follow-up period (RR, 0.94; 95% CI, 0.90-0.99). Abstinence-only intervention did not affect condom use. The 8-hour (RR, 0.96; 95% CI, 0.92-1.00) and 12-hour comprehensive (RR, 0.95; 95% CI, 0.91-0.99) interventions reduced reports of having multiple partners compared with the control group. No other differences between interventions and controls were significant.

Conclusion Theory-based abstinence-only interventions may have an important role in preventing adolescent sexual involvement.

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One thing I notice (which others have noticed, as well.)

Several critics of an abstinence-only approach said that the curriculum tested did not represent most abstinence programs. It did not take a moralistic tone, as many abstinence programs do. Most notably, the sessions encouraged children to delay sex until they are ready, not necessarily until married; did not portray sex outside marriage as never appropriate; and did not disparage condoms.

Wondering exactly how you could scientifically quantify that. How to people decide that Program X "did not take a moralistic tone", but that "many abstinence programs do"? Looks to me more like a statement of opinion. (Which doesn't mean it's not accurate.)

I do observe that this one supposedly did not discourage condoms, in the classroom or in reality.

I'll admit that when "abstinence only" first became a mantra, somebody on ES actually published some state's abstinence only law. And all it was was a really long of things which teachers were prohibited by law from mentioning. First on the list was that teachers were not allowed to mention condoms, except for the purpose of promoting their failure rate. That's one of the reasons I've opposed them for some time.

It is in the context of "this program did not disparage condoms" that I point at the concluding paragraph:

"There are populations that really want an abstinence intervention. They are against telling children about condoms," he said. "This study suggests abstinence programs can be part of the mix of programs that we offer."
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Here's a link to a PDF of the full study, in case anyone's interested:

http://bit.ly/bmtTcD

Look quick... I'll bet that gets taken down.

I think some could argue that if you waited until marriage you would be equally as challenged as those that started at 14.

I doubt that's true, but even if it is, the consequences of the one are far more benign societally than the consequences of the other, which include teenage pregnancy, STDs, continuing the cycle of poverty, etc.

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That's true, but this was apparently abstinence only, unless you think the lead researcher was confused about the meaning of the term:
That's not how I understood it, though maybe I just don't understand what abstinence only actually is.

"The abstinence-only portion involved a series of sessions in which instructors talked to students in small groups about their views about abstinence and their knowledge of HIV and other sexually transmitted diseases. They also conducted role-playing exercises and brainstorming sessions designed to correct misconceptions about sex and sexually transmitted diseases, encourage abstinence and offer ways to resist pressure to have sex."

Does that mean they don't discuss safe sex at all?

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I'll admit that when "abstinence only" first became a mantra, somebody on ES actually published some state's abstinence only law. And all it was was a really long of things which teachers were prohibited by law from mentioning. First on the list was that teachers were not allowed to mention condoms, except for the purpose of promoting their failure rate. That's one of the reasons I've opposed them for some time.

The authors of the study admit that their abstinence-only program would not meet federal standards. It specifically did not criticize condoms, and the teachers were required to correct any statements by the students that condoms don't work to prevent HIV or for birth control.

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That's not how I understood it, though maybe I just don't understand what abstinence only actually is.

This is how the study describes it:

Abstinence-Only Intervention

The 8-hour abstinence-only intervention encouraged abstinence

to eliminate the risk of pregnancy and STIs including

HIV. It was designed to (1) increase HIV/STI knowledge, (2)

strengthen behavioral beliefs supporting abstinence including

the belief that abstinence can prevent pregnancy, STIs, and HIV,

and that abstinence can foster attainment of future goals, and

(3) increase skills to negotiate abstinence and resist pressure

to have sex. It was not designed to meet federal criteria for abstinence-

only programs. For instance, the target behavior was

abstaining from vaginal, anal, and oral intercourse until a time

later in life when the adolescent is more prepared to handle

the consequences of sex. The intervention did not contain inaccurate

information, portray sex in a negative light, or use a

moralistic tone. The training and curriculum manual explicitly

instructed the facilitators not to disparage the efficacy of

condoms or allow the view that condoms are ineffective to go

uncorrected.

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